Forest Place Nursing Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Whilst some staff were intuitively caring, the provider and managers had allowed people to be continually exposed to the risks of poor and inappropriate care and had failed to take action to improve standards of care. This did not demonstrate a caring service. People’s personal care and intimate needs were not always being met. We observed people not always receiving timely support from staff and this compromised their dignity which meant the provider was in breach of regulation as those needs were not met.

Peoples care plans did not always contain sufficient information to manage people’s health needs, Information contained within people’s care plans was sometimes generic and lacked sufficient detail to enable staff to provide consistent good quality care.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt that staff were kind and caring towards the people they supported. One person’s relative said, “We like that the staff are always welcoming which helps us too. We feel [Person] is safe with the friendly and helpful staff.”

Staff spoke with an enthusiasm and willingness to provide care to people that met their individual needs and protected their privacy and dignity. One staff member said, “We are creating a community where everyone feels valued, heard, and cared for. This commitment to person-centred care helps build strong, trusting relationships with residents and their families.” However, managers could not always demonstrate they supported staff with the right resources and leadership to ensure the quality of care overall.

All partners spoken with were positive about the staff team and said in their experience staff were kind, caring and compassionate in their work. Despite this feedback they also shared concerns relating to oversight of personal care delivery, positive engagement with people, people being left in bed for extended periods, a lack of time for staff to carry out their tasks effectively to ensure peoples dignity was met. Partners said the provider, through their management of the service, did not enable staff to ensure people experienced the level of care that staff wanted to provide. Leaders did not demonstrate their approach was caring towards staff or people using the service.

People’s dignity was not always respected. During our onsite element of the assessment, we saw people’s catheter bags were full, in one observation made a connected catheter bag had been placed on a person’s pillow whilst they ate lunch, and personal care was not given in a timely way. We saw people supported on a 1 to 1 basis had staff present, yet staff did not demonstrate empathy or compassion to those people who required enhanced support and engagement. There was a lack of engagement with staff, focusing on completing a 15 minute observation checklist. They did not use nonverbal cues to show attentiveness or reflective listening to ensure understanding and demonstrate they were listening. Most were sat in silence, whilst the person they supported was either disengaged or becoming more and more restless. Where people were in their rooms, alone and in bed, staff acknowledged this with a call to them as they passed by. However, staff had not been provided with the training to enable them to engage proactively and meaningfully with people. Therefore, for some people living in the service staff did not engage with them to minimise their distress or anxiety and to help ensure those people who required assistance with personal care were treated as equal to those more independent.

The leadership team did not ensure systems were in place to always treat people as individuals or met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. People’s views about staff meeting their care, support needs and preferences were variable. Some people said they were offered choice and were happy their preferences were met. People and their relatives told us visitors were welcomed but there were restrictions on when they could visit due to no staff on reception out of hours. People could not describe how staff supported different cultural backgrounds. For example, one person stated, “The food we get is ok but not always to my particular culture’s tastes.”

Staff told us that people’s choices were acknowledged. However, this was not reflected on our observations and feedback from people, relatives and others. For example, being out of bed, choice of bath or shower, personal care delivery, engagement. Staff did convey some concerns, one staff member said, “For the wellbeing of the residents, activities are crucial. Those with limited mobility could benefit from more individualised options, even though there are some interesting activities offered.” We were told that there were no organised day trips because there was no available transport. People were not supported to visit the local shops, cafes or pubs. Staff said a local Methodist Church was available to meet those people’s religious beliefs, however there were no other faith organisations present in the home to support other people’s culture or beliefs.

Activities were available for people who could go to the lounge they were held. 2 activity staff did go into people’s rooms, but the duration was usually very short and the engagement not stimulating. For one person an activity staff member dropped in their room in the morning to deliver a newspaper. No other engagement that week was documented. The activity staff clearly tried to reach everyone in the home but for people in their rooms this was a difficult role to fulfil given the number in the room and the lack of activity staff.

Our observations showed staff were kind and well-meaning but lacked a person-centred approach, focusing on completion of tasks. Following our visit to Forest Place we met the provider who acknowledge there was a task based approach.

Care records did not always record details of people’s cultural, social and religious needs, or guide staff on how to ensure these were met. People’s communication needs were not always met to enable them to engage in their care, treatment and support to maximise their experience and outcomes. For example, care plans to support people with dementia recorded the behaviour, but did not consider the person’s ability to communicate may be a factor in them not understanding and becoming agitated or impatient.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and well-being. Assessments did not incorporate people’s interests and life history to support meaningful engagement. People who were cared for in bed were not encouraged to maintain their independence and were left alone for extended periods, sometimes without basic personal care being delivered. For those people, pressures on staff deployment meant that choices around how they spent their day where restricted meaning people could not engage with their choice of activity or choose how they spent their day. One relative said, “As for activities it varies on what [Person] will do, they (staff) need to know their preferences.” Relatives told us out of hours gaining access was difficult, meaning people did not always have free access to loved ones. One relative told us as a result they chose not to visit at certain times. They said, “The main reason I don't tend to come on the weekend is because the reception isn't manned on weekends so you can spend up to twenty minutes waiting for someone to let you in. There is no porch roof, so if it's wet you can get soaked waiting outside. It's the same after six o’clock, the same problems, you have to wait to get in the front door.”

Staff said they tried to support people’s independence and maintaining interests, hobbies and meaningful activity. However, feedback also showed that staff were under pressure and not always able to meet those needs to support wellbeing. One staff member said, “I believe activities are important for the residents' well-being and to help them feel at home. It would be better if we had more resources and enough staff to organise outings, like going for a drink, meals, or shopping. While we do our best with the current resources, having more support would make it easier for residents and staff to feel more like they're in a home environment.”

We saw five people enjoying activities which were organised by the activity organiser in one of the lounges. Those people seemed engaged with the activity and having fun. It was challenging for the two employed activity coordinators to see all 90 people each day. Organised activities were limited to when the activity organiser was available. Other staff did not provide consistent meaningful engagement outside of task-based care. People isolated in their rooms and those living with dementia had little opportunity for meaningful activities. We observed that some people were left to walk around the units without distraction. One person told their carer they would like to go outside because the sun was shining. The staff member told the person they should continue to sit in their chair, and they would take them later. Staff told us the garden areas were not used in the winter, even if the sun was shining. People told us they would like to use those communal areas all year round to either continue hobbies or just be outdoors.

Although staff collectively tried to support people’s independence and support them to pursue hobbies, interests and maintain relationships, processes did not support this. Staff deployment in the service meant two full time activity staff were expected to meet people’s social and wellbeing needs for 90 people with little additional provision at weekend. People were not supported to build their skills and independence. People did not receive care that respected their dignity and privacy.

People’s feedback was variable regarding understanding and meeting people’s needs. One relative said, “We think the carers here are wonderful people and we're happy that [Person’s] here now. These carers seem well enough trained, have a good attitude and go about their jobs confidently and well.”

However, others were not so confident about staff. One relative shared a poor experience which resulted in them feeling they needed to attend the service every day to assure themselves care was being provided. They told us “My perception is they're short staffed.”

A visiting professional raised concerns about observations on how staff interacted with people to minimise distress and distract them to keep them safe. Whilst staff could verbally explain different approaches, they would use to support a person who was showing signs of distress, care records did not always corroborate that these approaches were consistently used. The provider told us that a mental health lead regularly reviewed people’s care plans and supported staff with implementing positive behaviour plans. However, we found that improvements were needed to fully understand and embed current nationally recognised good practise to support people who may become distressed or anxious.

Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. Where people had one to one care, the plans for what staff needed to do were unclear. In one case we saw this resulted in a person becoming more distressed and the staff member being present but not engaging with them in a way which allayed their distress.

This resulted in them doing nothing else except being present in the person’s room. There was no exploration of different options to support the person.

People cared for in bed were mostly left alone through the day. Personal care was not always provided when needed, and staff did not take steps to encourage people to get up for parts of the day where that was an option.

Care records did not consistently document how to meet people’s needs, their views and wishes. Where people lived with dementia care records did not robustly document how staff should act to minimise any discomfort, concern or distress. The proprietor of Forest Place acknowledged this required improvement and started to develop their ‘This is me’ care record that they said would provide a guide for staff about people’s life histories, interests, hobbies, relationships and ways to positively engage with people.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.